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Objective: Robotic technology has diffused rapidly despite high costs and limited additive reimbursement by major payers. We aimed to identify the factors associated with hospitals' decisions to adopt robotic technology and the consequences of these decisions.

Methods: This observational study used data on hospitals and market areas from 2005 to 2009. Included were hospitals in census-based statistical areas within states in the State Inpatient Database that participated in the American Hospital Association annual surveys and performed radical prostatectomies. The likelihood that a hospital would acquire a robotic facility and the rates of radical prostatectomy relative to the prevalence of robots in geographic market areas were assessed using multivariable analysis.

Results: Hospitals in areas where a higher proportion of other hospitals had already acquired a robot were more likely to acquire one (P = 0.012), as were those with more than 300 beds (P < 0.0001) and teaching hospitals (P < 0.0001). There was a significant association between years with a robot and the change in the number of radical prostatectomies (P < 0.0001). More radical prostatectomies were performed in areas where the number of robots per 100,000 men was higher (P < 0.0001). Adding a single robot per 100,000 men in an area was associated with a 30% increase in the rate of radical prostatectomies.

Conclusions: Local area robot competition was associated with the rapid spread of robot technology in the United States. Significantly more radical prostatectomies were performed in hospitals with robots and in market areas of hospitals with robotic technology.

Acquisition of a robot by a hospital both increases the number of robotic prostatectomies performed at that hospital and encourages more area hospitals to acquire robots, leading to an increase in the number of radical prostatectomies performed on the area residents.